| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $456.30 | $456.30 | $971.75 |
Aetna
| Professional | AA | $899.10 | $1,465.38 | $1,960.00 |
Aetna
| Professional | QZ | $306.55 | $306.55 | $1,729.75 |
Cigna
| Professional | AA | $698.15 | $698.15 | $793.35 |